Co-morbidities in dementia: time to focus more on assessing and managing co-morbidities

Subramaniam, Hari

doi:10.1093/ageing/afz007

Cited by 17 publications

(15 citation statements)

References 20 publications

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“…Research has highlighted that there is a need for an elevated focus on assessing and monitoring comorbidities and their associated medications in PwD [33,34]. Comorbidity medication was high for most of the PwD in our dataset, as over 85% had been prescribed 15 or more comorbidity medications between 2010 and 2016.…”

Section: Discussionmentioning

confidence: 93%

Factors Associated with Mortality Including Nursing Home Transitions: A Retrospective Analysis of 25,418 People Prescribed Anti-Dementia Drugs in Northern Ireland

McMichael¹,

Zafeiridi²,

Passmore³

et al. 2020

JAD

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Background: Understanding factors associated with mortality after a dementia diagnosis can provide essential information to the person with dementia, their family, and caregivers. To date very little is known about the factors associated with mortality after a dementia diagnosis in Northern Ireland. Objective: To determine how demographic and other factors such as deprivation and comorbidity medications influence mortality rates after a dementia diagnosis in Northern Ireland and whether these factors are influenced through nursing home transitions. Methods: 25,418 people prescribed anti-dementia medication were identified through the enhanced prescribing database between 2010 and 2016. The impact of covariates including age, gender, marital status, deprivation measure, urban/rural classification, and comorbidity medications were examined using cox proportional hazard models with hazard ratios (HR) and 95% confidence intervals. Results: Between 2010 and 2016, 12,129 deaths occurred, with 114 deaths/1,000 person years. Males had significantly higher mortality rates in comparison to females (HR = 1.28; 95%CI = 1.23-1.33); this was true regardless of whether the person with dementia transitioned to a nursing home. People prescribed anti-dementia drugs living with lower levels of deprivation had significantly lower mortality rates in comparison to people living with the highest levels of deprivation (HR = 0.93; 95%CI = 0.89-0.97). Diabetic (HR = 1.18; 95%CI = 1.07-1.29) and anti-arrhythmic (HR = 2.44; 95%CI = 1.01-5.91) medication in particular significantly influenced mortality. Conclusion: Male gender, higher comorbidity medications, and living in areas of higher deprivation significantly increased mortality rates for people prescribed anti-dementia drugs in our study population. When comorbidity medications were classified, only anti-arrhythmia and diabetic medications significantly increased mortality. Future research should continue to investigate factors which influence mortality after a dementia diagnosis.

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Section: Discussionmentioning

confidence: 93%

Factors Associated with Mortality Including Nursing Home Transitions: A Retrospective Analysis of 25,418 People Prescribed Anti-Dementia Drugs in Northern Ireland

McMichael¹,

Zafeiridi²,

Passmore³

et al. 2020

JAD

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show abstract

“…With multimorbidity being a norm in the elderly popu-dominant or priority biomedical point of view, there is a risk that this pathology will attract all the attention of the GP, and other problems that can be very important for the elderly patient will not be taken into consideration [41]. Elderly patient with multimorbidity, more than any other, requires a unified evaluation of his disease, and when possible, the support and integration of his own family [6].…”

Section: Resultsmentioning

confidence: 99%

Doctor-Patient Relationship and Multimorbidity: The More Extraordinary a Case Seems, the Easier it is to Solve it

Jl¹

2019

Arch Fam Med Gen Pract

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On the other hand, multimorbidity occurs preferably in the elderly patient. Thus, these patients have special characteristics regarding communication and doctor-patient relationship [6]. Due to the aging of the population and due to the improvements in medical care, there is a life extension and so, it is more common for the older people to have to deal with more diseases (i.e. osteoarthritis, arterial hypertension, cardiovascular disease, diabetes, depression, COPD, loss of visual and auditory capacity, falls and immobility, osteoporosis, dementia, delirium, urinary incontinence, etc.). So, based on a series of studies (although with non-homogeneous diagnostic criteria), the prevalence rates in the elderly range from 55% to 98% [5,7]. Further, common chronic conditions in older people clus

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“…Forum participants extensively discussed information related to the care recipients’ health conditions with comorbidities, links between ADRD and comorbidities, and uncertainty of the root causes of some symptoms and behaviors. This may reflect the complex interactions of ADRD and its comorbidities [ 57 ] and the underlying causes of family caregivers’ struggles. Older adults without dementia have 2 comorbidities on average, whereas those living with dementia have an average of 4 comorbidities, and almost 9 out of 10 individuals living with dementia have at least one comorbidity [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

Diabetes-Related Topics in an Online Forum for Caregivers of Individuals Living With Alzheimer Disease and Related Dementias: Qualitative Inquiry

Du¹,

Paiva²,

Cebula³

et al. 2020

J Med Internet Res

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Background Diabetes and Alzheimer disease and related dementias (ADRD) are the seventh and sixth leading causes of death in the United States, respectively, and they coexist in many older adults. Caring for a loved one with both ADRD and diabetes is challenging and burdensome. Objective This study aims to explore diabetes-related topics in the Alzheimer’s Association ALZConnected caregiver forum by family caregivers of persons living with ADRD. Methods User posts on the Alzheimer’s Association ALZConnected caregiver forum were extracted. A total of 528 posts related to diabetes were included in the analysis. Of the users who generated the 528 posts, approximately 96.1% (275/286) were relatives of the care recipient with ADRD (eg, child, grandchild, spouse, sibling, or unspecified relative). Two researchers analyzed the data independently using thematic analysis. Any divergence was discussed among the research team, and an agreement was reached with a senior researcher’s input as deemed necessary. Results Thematic analysis revealed 7 key themes. The results showed that comorbidities of ADRD were common topics of discussions among family caregivers. Diabetes management in ADRD challenged family caregivers. Family caregivers might neglect their own health care because of the caring burden, and they reported poor health outcomes and reduced quality of life. The online forum provided a platform for family caregivers to seek support in their attempts to learn more about how to manage the ADRD of their care recipients and seek support for managing their own lives as caregivers. Conclusions The ALZConnected forum provided a platform for caregivers to seek informational and emotional support for caring for persons living with ADRD and diabetes. The overwhelming burdens with these two health conditions were apparent for both caregivers and care recipients based on discussions from the online forum. Studies are urgently needed to provide practical guidelines and interventions for diabetes management in individuals with diabetes and ADRD. Future studies to explore delivering diabetes management interventions through online communities in caregivers and their care recipients with ADRD and diabetes are warranted.

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Co-morbidities in dementia: time to focus more on assessing and managing co-morbidities

Cited by 17 publications

References 20 publications

Factors Associated with Mortality Including Nursing Home Transitions: A Retrospective Analysis of 25,418 People Prescribed Anti-Dementia Drugs in Northern Ireland

Factors Associated with Mortality Including Nursing Home Transitions: A Retrospective Analysis of 25,418 People Prescribed Anti-Dementia Drugs in Northern Ireland

Doctor-Patient Relationship and Multimorbidity: The More Extraordinary a Case Seems, the Easier it is to Solve it

Diabetes-Related Topics in an Online Forum for Caregivers of Individuals Living With Alzheimer Disease and Related Dementias: Qualitative Inquiry

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